The African bush and malaria are and an almost automatic association. At one time the northern areas of KwaZulu-Natal were viewed as downright dangerous. Early maps of malaria risk in South Africa show St Lucia as being the only area in the country where you could get malaria at any time of the year. Of course things have changed a great deal since then but one needs to keep looking at the situation critically.
Your chances of getting malaria as a tourist depends on many things, including the amount of malaria in the population of the surrounding area, the measures you take to protect yourself, the time of the year and the recent rainfall.
How do things look in KwaZulu-Natal now? In general good and looking towards the future there is hope for improvement.
Public health measures reduce the risk of malaria but don't guarantee that you the visitor will be safe from infection with malaria. Unfortunately there is not much new in the way of chemo prophylaxis. The current recommendations are Larium (Mefloquine) or the combination of Daramal (Chloroquine) and Paludrine (proguanil) or doxycycline.
Don't loose sight of other personal protection measures. You should never visit a malaria without taking along an effective repellent. This excludes citronella and any of the other naturals which only repel mosquitoes for a short time. Numerous studies have shown that the most effective repellent is Diethyl toluamide usually abbreviated to DEET. Mosquito coils are very effective in rooms or huts as are electrically heated pads containing insecticide. Sleeping under a mosquito net will prevent mosquito bites at night and long armed shirts and trousers is effective in evenings and mornings while not in bed.
In essence this is about the health of the people live in the area. Cost considerations mean that these people cannot afford prophylaxis. Few can even afford nets for their beds. As such they are reliant on the Malaria Control Programme to reduce the probability of getting malaria and the services of the local clinics and hospitals to cure them if they get infected.
Effective treatment of the disease is paramount. Any resistance in the parasite means the patient goes home uncured. He then has a resistant strain of malaria which will intern infect mosquitoes with the resistant malaria strains.
But drug resistance is not the only part of the malaria combat equation. Mosquito numbers must be limited. Since the reintroduction of DDT the mosquito populations are effectively being held in check.
It is no coincidence that the malaria risk is highest on our borders with our neighbor Mozambique. During the countries recent tragic history one of the victims was effective malaria control. Recently Malaria control has become reintroduced and the nock-on effect has already been noticed in Mpumalanga, Swaziland and KwaZulu-Natal.
It will still be a number of years before an effective vaccine is developed so don't hold you breath waiting for that.